Is the medical community more conservative than most and why?

maninasia

Ok, I made a hash of the first attempt at this.

Let's stick to discussing conservatism in the medical profession. Does it attract people who are already conservative or do people become conservative overtime?

Is it because of the hierarchial nature of the medical system and fear of higher-ups and upsetting the applecart?

Is it because medicine is always 'safety first'? ( this opens up another debate, for instance a classic one I always think of is the use of slimming drugs, sure some slimming drugs have serious side effects, yet obesity and the diseases it brings with it seem to be worse than the side effects of the drugs, another one would be the reluctance to introduce modern diagnostic/scientific tests and trusting of old fashioned direct analysis and interpretation by Doctor more)

Is it because the education system selects for studious types first and foremost?
Do medical professionals like to think of themselves as openminded and liberal but they don't actually apply that in their workplace?
Or are people in medicine no more conservative than other areas?

Discuss.

ORLY?

What is your definition of conservative?

I'm afraid you're not going to be able to judge much of anything about a doctor's personality unless you know them outside of the job.

Do you have any friends that are doctor's, are they "conservative"?

maninasia

Right next, anyone with an opinion please?

ORLY?

I have plenty of opinions. It might actually help though if you were capable of articulating yourself a bit better. You do realise that "conservative" has a broad meaning. It might help if you explained what you mean, maybe gave example of how the medical community is conservative?

You've made some vague nonsensical remark about diet pills and talked about some so-called reluctance to bring in diagnostic tests. I don't know what you're tyring to say with the diet pills and I haven't picked up on any reluctance to bringing in new diagnostic procedures.

Frankly, I have no idea what you're tyring to say, nor do you, or if you do, you certainly don't know how to express yourself.

maninasia

You are typical of a person hedging their bets and redirecting the conversation. I have made myself perfectly clear thank you. You unfortunately follow the extremely defensive tone on this section of Boards.

As for diet pills, the point is that if you actually check the death rate from side effects of the pills you might note that it is lower than the death rate from diseases related to obesity. It may make more sense to put most fat people on slimming pills but we just don't see it because of the extreme conservatism and reluctance to change (this is related to FDA etc.).

In addition, it is well known and has been discussed on here previously that GPs do not use all the available diagnostic tests out there, in fact they use VERY few even though a diagnostic test gives an objective result rather than a subjective result. In the scientific and technological world subjective analysis is usually frowned upon. An analysis should be built up from reliable data, not from a whole heap of assumptions and best guesses. GPs have been very slow to incorporate diagnostic tests. Now that might be because there are solid reasons for this or that they are simply conservative and slow to change their ways.

ORLY?

maninasia wrote: »

You are typical of a person hedging their bets and redirecting the conversation. I have made myself perfectly clear thank you. You unfortunately follow the extremely defensive tone on this section of Boards.

As for diet pills, the point is that if you actually check the death rate from side effects of the pills you might note that it is lower than the death rate from diseases related to obesity. It may make more sense to put most fat people on slimming pills but we just don't see it because of the extreme conservatism and reluctance to change (this is related to FDA etc.).

In addition, it is well known and has been discussed on here previously that GPs do not use all the available diagnostic tests out there, in fact they use VERY few even though a diagnostic test gives an objective result rather than a subjective result. In the scientific and technological world subjective analysis is usually frowned upon. An analysis should be built up from reliable data, not from a whole heap of assumptions and best guesses. GPs have been very slow to incorporate diagnostic tests. Now that might be because there are solid reasons for this or that they are simply conservative and slow to change their ways.

I'm not being defensive, just trying to figure out what you're talking about. Now that you've put some substance behind some of your points I can have a go at addressing them.

Anti-obesity medication - I have often seen it prescribed quite a bit.

As for your point on GPs not using all available "diagnostic" tests, of course they don't. The lab would be clogged up, it would cost a fortune, because of the delays seriously ill people would not be diagnosed in time and then we'd be left with a whole load of healthy people with "abnormal" results that we didn't know what to do with.

If we just threw every available test at everyone, there wouldn't be a need for GPs and the general health of the nation would decrease and the budget deficit increase.

It's common sense, and best use of resources and minimising risk for patients and maximising the nation's health. It's nothing to do with "conservatism".

maninasia

What's your opinion on the anti-obesity pills?

As for diagnostic tests, I think common sense could be argued the other way, that a diagnostic test could give an accurate result (e.g. rapid test) that would save medical costs down the line and reduce need for human intervention (I am not the biggest fan of commonsense as it is too easy to skew to the 'current' way of doing things).

ORLY?

maninasia wrote: »

As for diagnostic tests, I think common sense could be argued the other way, that a diagnostic test could give an accurate result (e.g. rapid test) that would save medical costs down the line and reduce need for human intervention (I am not the biggest fan of commonsense as it is too easy to skew to the 'current' way of doing things).

I don't know enough about anti-obesity meds to talk about their benefits or disadvantages.

As for what you say above, who should get which tests and when?

maninasia

I'm sure there is a procedure that can be put in place. Somebody presents with a cough, runny nose etc. Hey I'm not a doctor but the diagnostic test should inform the final decision, working on a more scientific basis. It is incredible to me that a GP cannot accurately diagnose a flu or cold virus or even the strain of flu or cold (well they do but they don't use these tests regularly and they are not actually that expensive compared to prescription drugs some I'm wondering is it a resistance to technology or overconfidence in personal abilities or a cultural relic).

If one was a doctor it would make sense to look at 'if I prescribe anti-obesity drugs to most obese patients, even with side-effects, will they be better off in the main?'

I suspect many doctors are reluctant to do this due to training and also importanly liability i.e. the 1 in a 1000 that died from an anti-obesity drug side-effect caused heart attack would sue you but the 20 out of 100 that died from an obesity related heart attack won't sue you!

Dr Galen

why would a doctor need to diagnose the strain of cold or flu that someone is presenting with? In most cases the treatment would vary very little regardless of the strain. If you have a cold, you've got a cold, don't need bloods to be sent to decide on a treatment option tbh.

Regarding diet pills, well could you post some of the sources that you've read regarding death rates and how they compare to deaths from obesity related illnesses? Sounds interesting as a thought experiment if nothing else. Do you have any info on other side effects from said pills? Like other than death.

drkpower

I think you might have made a hash of your 2nd attempt also......;)

maninasia wrote: »

I'm sure there is a procedure that can be put in place. Somebody presents with a cough, runny nose etc. Hey I'm not a doctor but the diagnostic test should inform the final decision, working on a more scientific basis. It is incredible to me that a GP cannot accurately diagnose a flu or cold virus or even the strain of flu or cold !

As Dr G says, there is no point in doing a test if it does not change the management of the patient. It is a very sensible cornerstone of medicine. There are a thousand examples; this is one of them. Identifying the strain of a cold or flu virus is not going to make any difference. Nothing to do with conservatism........NEXT!

maninasia wrote: »

If one was a doctor it would make sense to look at 'if I prescribe anti-obesity drugs to most obese patients, even with side-effects, will they be better off in the main?' I suspect many doctors are reluctant to do this due to training and also importanly liability i.e. the 1 in a 1000 that died from an anti-obesity drug side-effect caused heart attack would sue you but the 20 out of 100 that died from an obesity related heart attack won't sue you!

Are doctors reluctant to prescribe authorised anti-obesity medications? Im not sure they are. But you might provide more info on this, coz noone seems to know where you are coming from.

The 2 examples you have given of the medical professions innate conservatism are not especially good. There are others, though. My number one example of conservatism is their reluctance to speak out on issues that affect their patients, to speak out against policy, or against their colleagues. Not sure 'conservatism' is the appropriate tag though; it is probably more self-interest.

0lddog

ORLY? wrote: »

If we just threw every available test at everyone, there wouldn't be a need for GPs and the general health of the nation would decrease and the budget deficit increase......

Is anyone suggesting that every available test should be thrown at everyone ?

Why would there be no need for GPs. ?

"The general health of the nation would decrease" - any proof ?

ORLY? wrote: »

As for your point on GPs not using all available "diagnostic" tests, of course they don't. The lab would be clogged up, it would cost a fortune, because of the delays seriously ill people would not be diagnosed in time and then we'd be left with a whole load of healthy people with "abnormal" results that we didn't know what to do with.

In fact the position is that seriously ill people are not being diagnosed in time due to GPs reluctance to use / ignorance of available tests.

For myself, I think that maninasia is being very polite in suggesting that the issue is one of "conservatism" in the medical profession.

Rodin

maninasia wrote: »

You are typical of a person hedging their bets and redirecting the conversation. I have made myself perfectly clear thank you. You unfortunately follow the extremely defensive tone on this section of Boards.

As for diet pills, the point is that if you actually check the death rate from side effects of the pills you might note that it is lower than the death rate from diseases related to obesity. It may make more sense to put most fat people on slimming pills but we just don't see it because of the extreme conservatism and reluctance to change (this is related to FDA etc.).

And fat people, renowned for their self control, will take these tablets religiously?

Rodin

maninasia wrote: »

I suspect many doctors are reluctant to do this due to training and also importanly liability i.e. the 1 in a 1000 that died from an anti-obesity drug side-effect caused heart attack would sue you but the 20 out of 100 that died from an obesity related heart attack won't sue you!

I'd imagine those 21 people wouldn't be in a fit state to sue anyone

SomeDose

maninasia wrote: »

If one was a doctor it would make sense to look at 'if I prescribe anti-obesity drugs to most obese patients, even with side-effects, will they be better off in the main?'

I suspect many doctors are reluctant to do this due to training and also importanly liability i.e. the 1 in a 1000 that died from an anti-obesity drug side-effect caused heart attack would sue you but the 20 out of 100 that died from an obesity related heart attack won't sue you!

First of all, the terms "diet pills" or "anti-obesity drugs" are essentially meaningless. That could mean anything from amphetamines to anti-diabetic medicines, so you need to specify exactly which class or individual drugs you're talking about.

Secondly, you've made a quantum leap of an assumption when you questioned why doctors don't prescribe them. You're assuming the "diet pills" actually work, and have a significant benefit on morbidity and mortality. Do they?

ORLY?

0lddog wrote: »

In fact the position is that seriously ill people are not being diagnosed in time due to GPs reluctance to use / ignorance of available tests.

Is that so? Thanks for clearing that up for us.

Dr Galen

maninasia wrote: »

I'm sure there is a procedure that can be put in place. Somebody presents with a cough, runny nose etc. Hey I'm not a doctor but the diagnostic test should inform the final decision, working on a more scientific basis. It is incredible to me that a GP cannot accurately diagnose a flu or cold virus or even the strain of flu or cold (well they do but they don't use these tests regularly and they are not actually that expensive compared to prescription drugs some I'm wondering is it a resistance to technology or overconfidence in personal abilities or a cultural relic).

If one was a doctor it would make sense to look at 'if I prescribe anti-obesity drugs to most obese patients, even with side-effects, will they be better off in the main?

I suspect many doctors are reluctant to do this due to training and also importanly liability i.e. the 1 in a 1000 that died from an anti-obesity drug side-effect caused heart attack would sue you but the 20 out of 100 that died
from an obesity related heart attack won't sue you!

Just a wordnto the wise OP. It's not generally considered good form to go bak to posts that you have previously written and people have subsequently responded to, and edit them. It tend to disrupt the flow of conversation and debate.

By all means clarify your points but this is usually done in a separate post not by editing a previous one, unless your dealing with special cases. Which we aren't

0lddog

ORLY? wrote: »

Is that so? Thanks for clearing that up for us.

You are both welcome

Please give my secretary two hundred Euros on your way out

ORLY?

drkpower wrote: »

My number one example of conservatism is their reluctance to speak out on issues that affect their patients, to speak out against policy, or against their colleagues. Not sure 'conservatism' is the appropriate tag though; it is probably more self-interest.

I'd have to agree with this. I'd call it being meek. There is a tendency to be extemely career conscious, leading to excess deference.

This might explain why so many consultants seem to be eh, somewhat eccentric, maybe it's the release of having to toe so many lines for so many years.

No offence to any consultants here.:)

Tree

Im going to step in from the diagnostics side, i've said this many times before. Not all testing is nessecary, it doesnt always provide additional information, it's a burden on the tax payer when it's done unnessecarilly, the new tests dont always ahve the same level of proven accuracy/sensitivity.

Most people are suffering from the majority of illnesses that do not benefit from more detailed testing than is done currently. Focus should instead be put on implementing prevention and screening programmes that we can genuinely provide accurate and valid results for in order to intervene early to ultimately save lives and cut costs.

Throwing diagnostics at a problem will rarely solve anything, a lot of the effort is on the side of the clinician and their experience in dealing with such cases in the past and from reading the literature.

tallaght01

Surely everyone can see that the OP is just looking for an argument? This is just a (very) thinly veiled attack.

Tree

tallaght01 wrote: »

Surely everyone can see that the OP is just looking for an argument? This is just a (very) thinly veiled attack.

But lookee the wickle troll, how could you not feed the poor thing, staring back up at us with its big doleful eyes

Prime Mover

Most professions that have a long history also have a degree of conservatism and tradition. Look at the legal profession. Speaking of which, Ireland being one of the most litigious countries in the world has a big affect on how doctors deal with patients.

With regard to those two strange examples:
- if you put patients straight on to drugs instead of attempting lifestyle modification there would be others on here posting that you were a tool of big pharma. Also, some of those drugs have a bad history
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm179871.htm

- you also seem to have no faith in clinical examination. Some signs can actually be quite specific. Also you avoid the VOMIT (victims of modern Imaging/investigation technology) scenarios.
http://www.bmj.com/content/326/7401/1273.1.extract

sam34

OK can we leave out the sniping and snide remarks please

maninasia

Again diagnostics are being written off far too quickly here. For instance, it is my impression (might be wrong again) that doctors can find it difficult to differentiate between a cold and flu. To my knowledge a flu is worse than a cold and should be treated more seriously. The strain of flu is also important, especially during pandemics. Then you've got bacterial infections that might be dangerous or confused with a flu/cold. So why not get science involved and more data to back up decisions making, diagnostic tests are relatively cheap, especially rapid tests. Why not take patients seriously when they say 'I want to know what disease I have', instead of sending them home and say you'll be fine in a few days.

I'm not totally talking out of my hat here as I am involved in life sciences.

There are people saying here that it is too costly, but I'm not sure I agree with this argument if you think it through. A GP is very costly to visit, a hospital stay is costly, prescribed drugs are extremely costly.

Then the obesity thing, you guys are the doctors not me. I am surprised you do not have any professional opinions on the matter. It is well known obesity is a leading cause of death, a drug that cuts fat peoples weight dramatically and long-term would obviously cut the fatality/serious illness rate dramatically, it should then depend on the relative serious of side-effects to make a decision. Where's the debate on this?

Rodin

A doctor that can't tell between a cold and a flu is not worth paying your money too.

And doing a PCR on a virus to see if it's adenovirus or Influenza. Ok, you know have the subtype. What are you going to do with this expensively obtained information? Back of the chart it goes.
Get real.

maninasia

You don't need to do PCR all the time, rapid tests can cover major flu subtypes, but if you look into PCR/NAT tests and technology are improving very rapidly. You may eat your own words in a few years.

Then you claim the tests are expensive, test for flutype A/B are less than a dollar (if centrally purchased). A has a high chance of being H1N1 virus. Don't belittle my concerns.

Seriously why the defensiveness, diagnostics is a tool to aid, not to be afraid of. Obviously the lack of concrete data is a major concern when doing a patient analysis. Look at how a modern car mechanic checks for faults. The cars are all wired up electronically now and the first thing they do is run a diagnosis program through a laptop, THEN they go ahead to do a manual inspection. Mechanics, some of the most traditional hands-on people, run with the technology and appreciate how it helps them make faster and better decisions.

Rodin

How much does this diagnostics testing cost? Hmm?

And a car is infinitely more simple than the complex human body.

Diagnostic tests are used by clinicians when they are financially prudent, and clinically justified to select treatment

And whats the actual turn around time for your influenza testing?
And I dont mean the time required for the test itself. I mean getting the sample to a lab, waiting in the queue behind the other samples, and then the report coming back. And you want everyone with the start of a sniffle to get this done?

maninasia

Rodin wrote: »

And fat people, renowned for their self control, will take these tablets religiously?

This is a very ignorant statement to make. Fat people, as you should know, are fat for many different reasons. There are plenty of slim people with no self control.

maninasia

Rodin wrote: »

How much does this diagnostics testing cost? Hmm?

And a car is infinitely more simple than the complex human body.

Diagnostic tests are used by clinicians when they are financially prudent, and clinically justified to select treatment

And whats the actual turn around time for your influenza testing?
And I dont mean the time required for the test itself. I mean getting the sample to a lab, waiting in the queue behind the other samples, and then the report coming back. And you want everyone with the start of a sniffle to get this done?

Seems you don't have a clue about rapid tests, results ready in 10 minutes.
http://www.craigmedical.com/Influenza.htm

Rodin

maninasia wrote: »

This is a very ignorant statement to make. Fat people, as you should know, are fat for many different reasons. There are plenty of slim people with no self control.

Fat people are fat for ONE reason only.
Their calorie intake exceeds their body's requirement.